Abstract
The aim of this chapter is to discuss the physiology of respiratory drive and techniques to monitor and modulate drive, as relevant to ICU patients. Respiratory drive is the intensity of the output of the respiratory centers and determines the effort to breathe. A combination of chemical, mechanical, behavioral, and emotional factors contributes to respiratory drive. The most important receptors that provide feedback to the respiratory centers are central chemoreceptors sensitive to changes in pH in the cerebrospinal fluid. High and low respiratory drive can be present in critically ill patients under mechanical ventilation. High or low respiratory drive may worsen, or even cause lung injury and diaphragm injury. Several techniques are available to monitor respiratory drive in critically ill patients, including clinical evaluation, diaphragm electromyography, the airway occlusion pressure (P 0.1), and transdiaphragmatic pressure. Monitoring and modulating respiratory drive may limit the clinical impact of high or low respiratory drive on the lungs and diaphragm. Potential strategies to modulate respiratory drive towards physiological levels include adaptation of ventilator inspiratory support, medication (e.g., opioids, sedatives), and extracorporeal CO2 removal. The impact of modulating respiratory drive on patient outcome requires further evaluation.
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Jonkman, A.H., de Vries, H.J., Heunks, L.M.A. (2020). Physiology of the Respiratory Drive in ICU Patients: Implications for Diagnosis and Treatment. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2020. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-37323-8_1
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